Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan Hospital: a 10-year retrospective study
|
|
- Russell Pearson
- 5 years ago
- Views:
Transcription
1 Ongom et al. BMC Gastroenterology 2014, 14:86 RESEARCH ARTICLE Open Access Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan Hospital: a 10-year retrospective study Peter A Ongom 1*, Christopher K Opio 2 and Stephen C Kijjambu 3 Abstract Background: Adult intussusception is a rare clinical condition worldwide. It contributes to less than 5% of all cases of intussusception. Few studies have been conducted in low-income countries compared to high-income countries; particularly Sub-Saharan Africa. Based on anecdotal evidence, the authors hypothesized that the condition is not as rare in a Sub-Saharan setting in comparison with western countries. We set out to conduct the first review study of adult intussusception in Uganda. Methods: The medical records of 37 (out of a total of 62 cases) adolescent and adult patients with a postoperative diagnosis of intussusception at Mulago National Referral and Teaching Hospital, from January 2003 to December 2012, were analyzed. The clinical features, diagnosis, treatment and pathologic features of lesions for these patients were reviewed. Intraoperative findings were described with reference to: the site of the intussusception, and the triggering lesion (either idiopathic or with a lead point). Results: The mean age was 33.6 years, with a range of years. The male to female ratio was 1.85:1. The mean number of days for which symptoms had been present prior to presentation was 6.3 days, while the median was 4 days. All 37 patients presented with abdominal pain. Only 13 (35.1%) had the classical paediatric triad of abdominal pain, a palpable abdominal mass and bloody stool. Most of the remaining patients presented sub-acutely with non-specific symptoms. A lead point was present in 28 patients (75.7%). Of these, 24 (64.9%) cases involved tumours. Among the tumours, 54.2% were malignant. Treatment did not involve intussusception reduction in 14 patients (37.8%). Some form of operative surgery was conducted in 31 (83.8%) patients; mainly segmental bowel resections and hemi-colectomies. Conclusion: Adult intussusception is uncommon in the Uganda, though probably less so than in western countries. It presents sub-acutely or chronically and is often diagnosed at laparotomy. Lead points are the triggering lesion most times and are due mainly to tumours. The bulk of tumours are malignant. Most patients require surgical resection, with prior reduction done in selected cases. Keywords: Adult intussusception, Sub-acute and chronic symptoms, Tumour, Malignancies, Lead point, Idiopathic, Reduction, Resection Background Intussusception is the invagination of a segment of the intestine into the lumen of another immediately adjacent segment. This is usually in a proximal-to-distal fashion. Adult intussusception (AI) is relatively uncommon, constituting less than 5 percent of intussusception cases [1]. In high-income countries, there is an incidence of two * Correspondence: petongom@yahoo.co.uk 1 Colorectal Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda Full list of author information is available at the end of the article to three per 1,000,000 per year representing 1 to 3 percent of all cases of intestinal obstructions [2,3]. It is estimated that only 5% of all intussusceptions occur in adults and approximately 5% of bowel obstructions in adults are the result of intussusception [4]. There is a demonstrable cause in the majority of cases, usually an intraluminal neoplasm. Previous studies point to a 70 to 90 percent existence of an underlying gut pathological cause [2,3,5]. These are mainly polyps and colonic malignancies. In contrast, childhood intussusception is a leading cause of intestinal obstruction Ongom et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
2 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 2 of 8 The pathophysiologic mechanism is the peristaltic movement of a lesion associated with the intussusceptum (invagination). Intussusceptions with no clear anatomical lesion are the primary or idiopathic type, present in 8 to 20% of cases, and more likely to occur in the small intestines [2,6,7]. In contrast, the secondary type, constituting the greater majority, is due to an existing gut pathological lesion. This lesion is best described as a lead point; a functional or structural lesion associated with the intussusceptum, postulated to be the trigger for intussusception. The commonest lead points are colonic malignant tumors, present in up to 60 percent of cases [2,4,5,8,9]. Benign tumours constitute the majority of the rest. The epidemiology of this condition in low-income, Sub-Saharan African countries has also been documented. In one Nigerian study, intussusception was responsible for 8% of intestinal obstruction cases [10]. A study in a Kenyan centre described ileocolic intussusception as the 4 th commonest cause of bowel obstruction [11]. Another Nigerian study described a male to female ratio of 1.4:1, with a mean age of 49.6 years [12]. Seventy seven percent of cases had definite causes identified; mainly polyps (31.8%) and colonic malignancies (18%). Ileocolic intussusception was the commonest variety. Bowel resection for colonic carcinoma, gangrenous bowel and irreducibility of the intussusception was done for 72.7% of patients, while manual reduction was successful in 27.3%. A 3-year Ethiopian study identified 2 peak ages of occurrence; the 2 nd and 4 th decades, associated mainly with idiopathic and secondary intussusception respectively [13]. The ileocolic type was present in 56% of cases. Benign conditions represented the majority (67%) of the identified lead points. Intraoperative reduction was successful in only 24% of the cases, all of which were idiopathic. AI often presents with non-specific symptoms. The majority of cases have been reported as chronic, a symptom consistent with partial obstruction [2,14]. The classic triad of crampy abdominal pain, bloody ( currant jelly ) stool, and a palpable mass of acute intussusception (characteristic of paediatric presentation), is rare. The predominant symptoms are those associated with some form of bowel obstruction, and are most times described as non-specific. These include: abdominal pain and distension, nausea, vomiting, gastrointestinal bleeding, constipation, and changes in bowel habits [8,15]. Preoperative diagnosis remains difficult, while whether the intussusception should be reduced, and the extent of resection, remains controversial [4]. The optimal surgical approach in adult intussusception is also debatable. More recently, manual reduction of the intussusception followed by definitive surgical resection has been advocated. Studies dating back 5 decades ago recommended primary resection without attempting reduction in all adult patients with intussusception, regardless of anatomic site, because of significant risk of associated malignancy [16]. This point was echoed more recently in a series in which malignancy was the cause in 65% of intussusceptions [8]. Thus, a controversy continues to focus on whether AI should be surgically resected without an attempt at reduction, for fear that undue operative manipulation of a malignant lesion may result in tumour dissemination [17]. Sub-Saharan Africa authors also describe the need for laparotomy for virtually all cases [12], with subsequent reduction. En-block resection of the involved intestinal segment is recommended if there is obvious ischemia, while limited resection is recommended if a only a lead point is identified [13]. We describe our experience of adult intussusception, and discuss the clinical presentation, aetiology and optimal surgical management in a large, tertiary hospital in Sub-Saharan Africa. Methods This was a retrospective study covering a 10-year period. The medical records of 62 adolescent and adult patients (13 years and above) with a postoperative diagnosis of intussusception at Mulago National Referral and Teaching Hospital, from January 2003 to December 2012, were collected. This hospital is located in Kampala, Uganda s capital city. Permission to carry out the study was granted by Mulago Hospital s Research and Ethics Committee. The clinical features, diagnosis, management and pathology of the 62 patients were reviewed. Twenty five patients were excluded from the study on account of incomplete or unclear records. Important information which led to these exclusions was that pertaining to: age, clinical features, intraoperative findings and procedure, and histological findings (when indicated). Operative procedures which did not involve resection did not necessarily have to have histology results for inclusion. Overall, we analyzed the records of 37 patients. The intraoperative findings were described in two contexts. One was the site of the intussusception, the other was the triggering lesion. The triggering lesion was descibed as either idiopathic or a structural, pathological lead point. An intussusception that involved only the jejunum or ileum was considered an enteric intussusception. That which involved the ileum and the colon was designated as an ileocolic intussusception, while that involving only the colon was considered a colocolonic intussusception [4]. More detailed site description was made to suit unique individual presentations, for example, sigmoidorectal intussusception. Procedures carried out were described according to the surgeon s notes. Essentially
3 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 3 of 8 there was bowel reduction, with or without resection, for all cases. Resection was either segmental or a colectomy. Patients records where followed-up for up to 2 weeks postoperative or up to the time of discharge, whichever came first. Available records were entered into Microsoft spread sheets and exported to Stata version 10 (StataCorp, Texas, USA) for detailed analysis. We generated descriptive stastistics that included frequencies/proportions, and measures of dispersion and central tendency. Results A total of 37 patient s records were analyzed. All diagnoses of intussusception were made intra-operatively. Of these, 24 (64.9%) were males and 13 (35.1%) females. The male to female ratio was 1.85:1 (Table 1). The mean age was 33.6 years, with a range of 59 (13 72) years. The 50 th percentile was 33 years and the interquartile range was 13 years, which meant that most patients were between the age of 20 and 46 years. The dominant ethnic group involved was the Ganda, 18 patients (48.65%); other ethnic groups, 11 in number, each contributed between 1 and 3 patients. Most patients (21; 56.8%) resided in Kampala (Uganda s Capital city) and Wakiso districts. All patients were symptomatic, with symptoms lasting from between 1 to 35 days. The mean duration for which symptoms lasted prior to presentation was 6.3 days (SD 7.59), with a 50 th percentile of 4 days. All 37 patients had a history of pain. The next two most frequent symptoms were nausea and vomiting, present in 35 (94.6%) and 28 (75.7%) patients respectively (Table 2). An abdominal mass was present in 22 (59.5%) patients. One patient had an ileocolic intussusception with anal protrusion [18], while another had a sigmoidorectal intussusception in combination with a rectal prolapse. Overall, the patients had an averagely sub-acute presentation, going by a popular classification [19]. Table 1 Summaries demographics of participants Patient demographics Total patients 37 Mean age (years) 33.6 Age range (years) th percentile; age (years) 33 Interquatile range; age (years) 13 Male: female ratio 1.85:1 Mean duration of symptoms (Days) 6.3 Median duration of symptoms (Days) 4 Benign: malignant 11:13 Demonstrable lead point: idiopathic 3.1:1 Table 2 Distribution of clinical features Clinical feature Number (%) CI (%) Pain 37 (100) Nausea 35 (94.6) Vomiting 28 (75.7) Constipation 18 (48.7) Distension 24 (64.9) Haematochezia 21 (56.8) Diarrhoea 8 (21.6) Abdominal mass 22 (59.5) Anal protrusion 2 (5.4) Shows the frequencies of symptoms and signs manifested by patients in the study. Both the ileum and the colon (ileocolic area) were involved in 16 (43.2%) patients, making that the commonest site (Table 3). Seven (18.9%) patients had only the small intestines affected. More specifically, the prominent sites involved in descending order of frequency were: ileocaecal, ileocolic, ascending colon, and transverse colon, with 8, 6, 4, and 3 patients respectively. A total of 28 cases (75.7%) had a demonstrable lead point. Majority of intussusceptions were initiated by adenocarcinoma and idiopathic causes, each having 9 patients, and totaling 18 (48.6%) patients (Table 4). All patients with adenocarcinoma had the lesion either in the colon or the ileocolic region; none being purely enteric. Overall, tumours were the cause of intussusception in 24 patients (64.9%). Of all tumours, 13 (54.2%) were malignant, 3 of them being in the small intestines. Gangrene or necrosis was present in 10 (27.0%) patients. In the treatment of the AI, complete bowel reduction was achieved in 17 (46.0%) patients (Table 3); surgical resection was not done. Five of these patients had only the small intestines involved. Six (16.2%) had partial reduction prior to resection, while in 14 patients (37.8%; CI ) reduction was not attempted at all. Thirty one patients (83.8%; CI ) underwent some form of surgical resection; 13 right hemicolectomy, 12 (32.4%; CI ) segmental bowel resection, 4 left hemicolectomy, and 1 extended right hemicolectomy. One patient had a sigmoid colectomy in combination with Hartmann s procedure (Table 3). Two patients presented with anal protrusion; one acutely, the other chronically. The patient with an acute presentation had precipitous symptoms lasting only minutes, before progressing to an acute intestinal obstruction. He had a sigmoidorectal type, with an adenoma as the lead point. Alongside this picture was a rectal prolapse. The prolapse/intussusception was reduced, and an incisional biopsy done. Histopathologic examination revealed it to be an adenoma. The patient with a chronic presentation had an ileocolic type, with an idiopathic cause. There
4 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 4 of 8 Table 3 Summary of operative findings at laparotomy and surgical procedures done Index number Histopathology/clinical diagnosis Location Necrosis/ gangrene Bowel reduction Surgical procedure 1 Idiopathic Ileocaecal Y N Segmental resection 2 Adenocarcinoma Ileocaecal N C Right hemicolectomy 3 Adenoma Colocolic (ascending) N N Right hemicolectomy 4 Non-specific inflammation Ileoileal Y N Segmental resection 5 Idiopathic Ileocaecal N C No resection 6 Idiopathic Ileoileal Y C Segmental resection 7 Adenocarcinoma Colocolic (descending) Y N Left hemicolectomy 8 Adenoma Colocolic (ascending) N P Right hemicolectomy 9 Idiopathic Ileocaecal Y N Right hemicolectomy 10 Adenocarcinoma Ileocolic N C No resection 11 Idiopathic Ileocolic N C No resection 12 Lymphoma Ileoileal Y N Segmental resection 13 Lipoma Ileocaecal N P Right hemicolectomy 14 Lymphoma Ileoileal N C Segmental resection 15 Lymphoma Colocolic (transverse sigmoid colon) N C Left hemicolectomy 16 Kaposi s sarcoma Ileoileal N N Segmental resection 17 Lipoma Ileocaecal N C Right hemicolectomy 18 Adenocarcinoma Ileocaecal N C Right hemicolectomy 19 Adenoma Ileocaecal N C Right hemicolectomy 20 Idiopathic Ileocolorectal, anal protrusion [18] N P Right hemicolectomy 21 Lipoma Colocolonic (transverse), N P Left hemicolectomy 'giant' lipoma; polyp [25] 22 Adenocarcinoma Colocolic (ascending) N N Right hemicolectomy 23 Adenocarcinoma Colocolic (ascending) N N Right hemicolectomy 24 Idiopathic Ileocolic Y N Segmental resection 25 Adenocarcinoma Colocolic (transverse) N P Extended right hemicolectomy 26 Adhesions Ileocolic Y N Segmental resection, Adhesiolysis 27 Adhesions Ileoileal N C Segmental resection, Adhesiolysis 28 Adenoma Colocolic (ascending) N C Right hemicolectomy 29 Adenocarcinoma Colocolic (descending) N P Sigmoid colectomy, hartmann's procedure 30 Adhesions Ileoileal N C No resection, adhesiolysis 31 Idiopathic Ileocolic Y N Segmental resection 32 Lipoma Ileocolic Y N Right hemicolectomy 33 Adenoma Colocolic (transverse) N C No resection, polypectomy 34 Idiopathic Ileocolic, ileal - transverse colonic N C Segmental resection 35 Adenocarcinoma Colocolic (transverse) N N Left hemicolectomy 36 Leiomyoma Colocolic (transverse), polyp N C Segmental resection 37 Adenoma Colorectal, sigmoidorectal with rectal proplapse N C Reduction and polyp biopsy Necrosis/Gangrene: Y present, N absent. Reduction: C complete reduction done, P partially reduced, N no reduction attempted. [18] and [25] indicate published references.
5 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 5 of 8 Table 4 Lesions associated with intussusception Lesion/lead point Number (%) CI (%) Benign causes 13 (35.1) Adhesions 3 (8.1) Idiopathic 9 (24.3) Non-specific inflammation 1 (2.7) < Benign tumours 11 (29.7) Adenoma 6 (16.2) Lipoma 4 (10.8) Leiomyoma 1 (2.7) < Malignant tumours 13 (35.1) Adenocarcinoma 9 (24.3) Lymphoma 3 (8.1) Karposi's sarcoma 1 (2.7) < Total 37 (100) was gross thickening and fibrosis, not allowing complete reduction. Resection had to be done. There was neither tumour nor gangrene. One patient with a transverse colonic polyp had a colonic incision made at the site of the pedunculated polyp, followed by polypectomy and minimal colonic resection, proximal and distal to the polyp s stalk attachment. Histopathologic examination revealed a leiomyoma. One patient who had had a right hemicolectomy, developed an enterocutaneos fistula one week postoperative. He recovered on non-operative management. There were no deaths recorded. Discussion We show that AI is not rare in this study setting; ages 13 to 72 years. A related Ethiopian study described the condition as not being rare in adults [13]. All our patients presented with pain. Other prominent symptoms were nausea and vomiting. Tumours formed 2/3 of the causes of AI. The study resulted in the analysis of 37 participants, with a male to female ratio of 1.85:1, a mean age of 33.6 years and a range of 59 (13 72) years. The mean number of days for which symptoms had been present prior to presentation was 6.3 days, while the median was 4 days. Only 13 (35.1%) patients had the classical paediatric triad of abdominal pain, a palpable abdominal mass and bloody stool. On average, most of the remaining patients presented sub-acutely with non-specific symptoms. A pathological lead point was present in 28 patients (75.7%). Of these, 24 (64.9%) cases involved tumours. Among the tumours, 54.2% were malignant. Treatment did not involve bowel reduction in 14 patients (37.8%). Surgical resection was conducted in 31 (83.8%) patients. Generally AI is unique when compared to its paediatric form in that it is rare, accounting for only 5% of all cases of intestinal obstructions. The mechanism, though still unclear, is believed to be the result of any lesion in the bowel wall, or irritant within the lumen, that alters normal peristaltic activity, thereby initiating invagination. As seen in other studies, our study had males more affected than females (1.85:1) [2,12]. However, some authors have reported reciprocal findings [17]. The mean age of 33.6 years is lower than that reported in some previous studies [2,12,20]. A related Sub-Saharan study reported 2 peak age groups; during the second and fourth decades [13]. Our mean age, within the fourth decade, is comparable to that study s findings. Ethnicity and residence are important to describe, since they illustrate the study setting we are in. The dominant ethnic group involved was the Ganda (Bantu), 18 patients (48.65%). This is plausibly explained by their being the dominant population in the greater Kampala region, in comparison to the multiple ethnic groups from the rest of the country [21]. Moreover, they are also the most populous ethnic group in the entire country. In turn, the majority of patients (21; 56.8%) resided in Kampala and Wakiso districts, both urban and semiurban areas. These districts are the key catchment area for Mulago Hospital. We cannot comment on the association between ethnicity and AI from this study. The clinical presentation of intussusception in this study varied considerably, as is the case in most other studies. Presenting symptoms were largely non-specific, and functionally leaned towards features of partial obstruction [2,14]. The mean duration for which symptoms lasted prior to presentation, 6.32 days, makes our series a sub-acute type [19]; 4 to 14 days duration. Symptom durations of < 4 days describe acute presentation, while durations > 14 days relate to chronicity. Seventeen (45.9%) patients, a sizeable proportion, presented with acute symptoms. This is in contrast to the mean duration for other studies which point to more chronic presentations; Azar et al. had a mean of 37.5 days [2], while Rathore et al. had a series with the shortest symptom duration being 2 weeks [20]. A possible explanation for this is the inclusion of adolescents (in our study) who have a shorter duration of symptoms, more related to the acute paediatric presentation, thus lowering the mean age for our entire group. The most common symptoms of pain, nausea and vomiting, were also observed in several other studies [1,2,4,5,20]. Haematochezia, diarrhoea, changes in bowel habits, constipation, and abdominal distension, are other non-specific symptoms and signs present in our series, yet also prominent in others [8,15]. The respective prevalences for all these are comparable (Table 1). Anal protrusion, which represented 5.4% of our cases, is a rare clinical feature, usually reported as individual case reports. Previous studies have described abdominal masses as being palpable in 24% - 42% of patients [2,6,22]. The
6 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 6 of 8 presence of a shifting mass or one that is palpable only when other symptoms are present is suggestive of intussusception. In our study this specific characteristic was not particularly noted. An abdominal mass was present in 59.5% (CI ) of patients. We postulate that the inclusion of adolescents, who may have more of the classic presentation, with its characteristic mass, account for this higher percentage. Other studies have had a lower age limit of 18 years for participants. Furthermore, we still had 13 (35.1%; CI ) patients with the classical paediatric traid, a higher proportion compared to another documented observation of 9.8% [9]. The adolescence factor could yet again account for this. The low proportion of classical presentation is one of the reasons why pre-operative diagnosis is difficult in these patients. AI is also classified according to the presence or absence of a demonstrable lead point, and by the location of the lesion; enteric, colonic or border-line (ileocolic). Intussusception with an organic lesion as the lead point usually presents as a bowel obstruction, persistent or relapsing, necessitating definite surgical therapy. Our study had 24.3% (CI ) of cases with idiopathic presentation, meaning no demonstrable lesion (Table 2). Though this is a higher prevalence, our study compares well with other study observations of 8 20% [2,6,7]. A demonstrable pathological lead point, the hallmark of AI, was seen in the majority (28 patients), constituting 75.7% (CI ). Most documented studies also have their cardinal observation as the vast majority of cases being non-idiopathic, with percentages of 83.3% [19], 86.4% [4], 90% [5], 90.9% [9] and 93% [2] having been reported. Our study is comparable to these. In our study, the ileocolic area was the most involved site, followed by the small intestines alone; a combined contribution of 62.2% of all cases. This is in keeping with previous studies [2,4,9]. Of the 75.7% of cases with physical lead points, 24 (64.9%) were tumours, still a characteristic finding in other clinical studies [1,2,4]. Furthermore, 54.2% (CI ) of the tumours were malignant, representing 35.1% (CI ) of all lesions (Table 4). This is comparable with the description of nearly half of intussusceptions in patients > 15 years being due to malignancy, documented by Barussaud et al. [23]. Other authors have also reported comparable contributions by malignant lesions to the overall intussusception burden. These include prevalences of 36% [4], 45% [9] and 46.6% [2]. This malignant property has a direct bearing in decision making during surgery. The 54.2% (CI ) presence of malignancy, per se, among all tumours, is also comparable to some previously documented studies. These documented prevalences include 72.7% [4], 75% [2], 50% [9] and 22.2% [5]. Ten intussusception cases were caused by malignancies either involving the ileocolic area or the colon only (Table 3). Furthermore, 3 out of 15 cases (20%; CI ) of ileocaecal/ileocolic intussusception had a malignancy. Wang et al. [19] reported relatively similar findings; 5/12 (42%) patients had malignant lesions in this type of intussusception. The commonest malignancy in our study was adenocarcinoma with 9/13 (69.3%; CI ) of all malignancies. All of these occurred in the ileocolic or colocolic location. Barussaud et al. described 85% of purely colonic lesions as being adenocarcinomas [23]. Our findings compare well with this study and other studies, emphasizing the fact that the vast majority are adenocarcinomas. Another important issue regarding colonic intussusception was noted in a review study by Marinis et al. and other authors. They reported 66% of intussusceptions occurring in the colon as being secondary to malignancy [1,6,17]. As regards benign tumours, adenomas and lipomas (the most frequent forms [1,2,4]), were present in 6 and 4 cases respectively. All these were present in the ileocolic and colocolic types. They constituted 27% (CI ) of all cases. Other comparable studies have reported prevalences of 18.2% [1] and 25% [9]. The presence of necrosis and/or gangrene in 27.0% (CI ) of cases highlights the low association of sub-acute symptoms with these conditions. On the one hand, a more acute presentation would possibly show a higher frequency of necrosis/gangrene. On the other hand, a more chronic symptom presentation would tend to give a lower frequency, as described by Wang N et al. [9]. They described a lower frequency of 6.8%. Generally, few studies report specifically on this entity. Because of the variability in clinical presentation and the varied nature of diagnostic imaging, it is common for the diagnosis to be made only at the time of laparotomy [6]. In this study we did not report on the preoperative imaging investigations due to the non-uniform way in which they had been done. In most cases, no imaging was done. Otherwise, plain abdominal radiography and ultrasonography were the modalities used. No patient had an abdominal computerized tomography (CT) scan done. This very sensitive and specific investigation is very good for early diagnosis and decision making. Most authors agree that laparotomy is mandatory in the treatment of AI, given that most cases have underlying pathological lesions. However, whether or not the intussusception should be reduced before resection remains controversial. Objections to reductions are theoretically based on: the possibility of intraluminal seeding and venous dissemination of malignant cells; possible perforation during manipulation; and the increased risk of anastomotic complications in the presence of oedematous
7 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 7 of 8 and inflamed bowel [4]. The prevalence of 32.4% (CI ) segmental bowel resections done among our patients, with and without reduction, is comparable with previous studies which described prevalences of 45% [5] and 43.9% [19]. There was a tendency to reduce enteric intussusceptions, partially or completely (Table 3). This is ostensibly because most surgeons go by the general principle of most enteric tumours being benign. No reduction was done in 14 cases (37.8%; CI ), 11 of these involving the colon (colocolic or ileocolic). The colon-associated cases instead underwent definitive hemicolectomies. This observation, which also describes those who underwent resection without a prior attempt at reduction, is comparable to a 25% prevalence in a previous study [5]. It is suggested by many authors that if the underlying etiology and/or the lead point is suspected to be malignant, or if the resected area required without reduction is not massive, an en bloc resection of the intussusception should be considered. We observe that in patients with ileocolic, ileocaecal and colocolic intussusceptions, formal resections using appropriate oncologic principles were used in our centre. Primary anastomosis between healthy and viable tissue was done as is recommended [6,8,17,24]. Generally, large bowel should be resected without reduction because pathology is mostly malignant. For rightsided colonic intussusceptions, resection and primary anastomosis can be carried out even in unprepared bowel. However, for left-sided or rectosigmoid cases, resection with construction of a colostomy or performance of a Hartmann s procedure, followed later by secondary anastomosis, is recommended especially in emergencies. We had one Hartman s procedure performed. Chronic intussusception, also present in this series, does not often allow for successful manual reduction to be performed due to thickening, fibrosis and crossscarring within the intussusceptum [25]. Enteric intussusceptions due to benign lesions require only reduction and limited resection [19]. We encountered this in 4 cases of enteric intussusceptions, and one colocolic case. Reduction alone is adequate for idiopathic forms provided the bowel appears non-ischemic and viable [17]. Six of our patients had this done. However, one of them also had an incisional biopsy for a polyp (adenoma). Some patients at risk of short bowel syndrome require special consideration. We encountered a typical scenario in one case intussusception (ileocolorectal, with anal protrusion) involving almost the entire colon and a sizeable length of ileum. A substantial length of gut was milked up to the limit of its reducibility, followed by resection [25]. There was no postoperative mortality. This may be explained by 3 factors: the small number of patients, the short post-operative observation duration (maximum 14 days), and the sub-acute/chronic nature of AI (generally not associated with short term, high mortality rates). Other authors too have reported no mortality [9,4]. Only one patient with ileocaecal adenocarcinoma, who underwent a right hemicolectomy, developed an enterocutaneous fistula. He was treated conservatively, and recovered 3 weeks postoperative. Our study had its limitations. Firstly, it was a retrospective study, dependent on the accuracy of the patient case notes. Inadequate record keeping cost us 25 potential participants for analysis. Secondly, even where records were good, we could not get to the depth of the symptom of pain; continuous or crampy. Thirdly, the very important aspect of radiological investigation, vital in patient management, was not looked into. On top of this, the follow up period for the patients was not enough to fully assess their long term recovery. The exact duration of postoperative hospital stay was not included. Conclusion AI is a rare but challenging condition for the surgeon. In our setting this condition seems not be as rare as in other settings. We have seen that 62 patients had intussusception during this 10 year period, though we could analyze only 37 because of unsatisfactory records. This is an average of over 6 cases per year. Preoperative diagnosis is usually missed or delayed because of nonspecific and often sub-acute symptoms, without the pathognomonic (classic triad) clinical picture associated with intussusception in children. In our study we found it more practicable to look at intussusceptions diagnosed at operation, and then retrospectively analyze them. Radiological imaging was not described due to nonuniformity of records. Abdominal CT is considered as the most sensitive imaging modality in the diagnosis of intussusception and distinguishes the presence or absence of a lead point [1,4,5]. Due to the fact that AI is often associated with malignant organic lesions, surgical intervention is necessary, usually requiring formal resection of the involved bowel segment. Reduction can be attempted in small bowel intussusceptions provided that the segment involved is viable, or a malignancy is not suspected. Surgeons should be familiar with the various treatment options because the real cause of the intussusception is often only accurately diagnosed at laparotomy, and a number of these cases have uniqueness about them [18,25]. Competing interests The authors declare that they have no competing interests. Authors contributions PAO conceptualized the theme, collected the data and wrote the manuscript. CKO analyzed the data and co-wrote the manuscript. SCK edited the manuscript. All authors read and approved the final manuscript.
8 Ongom et al. BMC Gastroenterology 2014, 14:86 Page 8 of 8 Acknowledgement The authors wish to warmly thank Dr. Emmanuel Elobu for his contribution in data collection. We are also most grateful to Doreen Uchendi for her assistance in retrieval of patient records. We cordially thank Dr. Doruk Ozgediz, Yale Medical School, for his scientific and copy editing input. Author details 1 Colorectal Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. 2 Gastroenterology Unit, Department of Internal Medicine, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. 3 Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006, 21: Reijnen HA, Joosten HJ, De Boer HH: Diagnosis and treatment of adult intussusception. Am J Surg 1989, 158: Ongom PA, Wabinga H, Lukande RL: A 'giant' intraluminal lipoma presenting with intussusception in an adult: a case report. J Med Case Reports 2012, 6:370. doi: / x Cite this article as: Ongom et al.: Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan Hospital: a 10-year retrospective study. BMC Gastroenterology :86. Received: 25 August 2013 Accepted: 30 April 2014 Published: 5 May 2014 References 1. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T: Intussusception of the bowel in adults: a review. World J Gastroenterol 2009, 15: Azar T, Berger DL: Adult intussusception. Ann Surg 1997, 226: Croome KP, Colquhoun PHD: Intussusception in adults. Can J Surg 2007, 50:E13 E Zubaidi A, Al-Saif F, Silverman R: Adult intussusception: a retrospective review. Dis Colon Rectum 2006, 49: Yakan CS, Caliskan Makay O, Denecli AG, Korkut MA: Intussusception in adults: Clinical characteristics, diagnosis and operative strategies. World J Gastroenterol 2009, 15(16): Begos DG, Sandor A, Modlin IM: The diagnosis and management of adult intussusception. Am J Surg 1997, 173: Erkan N, Haciyanli M, Yildirim M, Sayhan H, Vardar E, Polat AF: Intussusception in adults: an unusual and challenging condition for surgeons. Int J Colorectal Dis 2005, 20: Nagorney DM, Sarr MG, Mcllrath DC: Surgical management of intussusception in the adult. Ann Surg 1981, 193: Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX, Guo KJ: Adult intussusception: A retrospective review of 41 cases. World J Gastroenterol 2009, 15(26): Lawal OO, Olayinka OS, Bankole JO: Spectrum of causes of intestinal obstruction in adult Nigerian patients. S Afr J Surg 2005, 43(2): Muyembe VM, Suleman N: Intestinal obstruction at a provincial hospital in Kenya. East Afr Med J 2000, 77(8): Ugwu BT, Mbah N, Dakum NK, Yiltok SJ, Legbo JN, Uba AF: Adult intussusception: the Jos experience. West Afr J Med 2001, 20(4): Kotisso B, Bekele A: Intussusception in adolescents and adults: a report on cases from Addis Ababa, Ethiopia, during a three-year period. Ethiop Med J 2007, 45(2): Martin-Lorenzo JG, Torralba-Martinez A, Liron-Ruiz R, Flores-Pastor B, Miguel-Perello J, Aguilar-Jimenez J, Aguayo-Albasini JL: Intestinal invagination in adults: preoperative diagnosis and management. Int J Colorectal Dis 2004, 19: Weilbaecher D, Bolin JA, Hearn D, Ogden W 2nd: Intussusception in adults: Review of 160 cases. Am J Surg 1971, 121: Sanders GB, Hagan WH, Kinnaird DW: Adult intussusception and carcinoma of the colon. Ann Surg 1958, 147(6): Eisen LK, Cunningham JD, Aufses AH Jr: Intussusception in adults: institutional review. J Am Coll Surg 1999, 188: Ongom PA, Lukande RL, Jombwe J: Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report. BMC Res Notes 2013, 6: Wang TL, Wu CC, Yu JC, Hsiao CW, Hsu CC, Jao SW: Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience. Dis Colon Rectum 2007, 50: Rathore MA, Andradi SIH, Mansha M: Adult intussusception A surgical dilemma. J Ayub Med Coll Abbottabad 2006, 18(3): Uganda Demographic and Health Survey Tan KY, Tan SM, Tan AG, Chen CY, Chng HC, Hoe MN: Adult intussusception: experience in Singapore. ANZ J Surg 2003, 73: Barussaud M, Regenet N, Briennon X, De Kerviler B, Pessaux P, Kohneh-Sharhi N, Lehur PA, Hamy A, Leborgne J, Le Neel JC, Mirallie E: Clinical spectrum and Submit your next manuscript to BioMed Central and take full advantage of: Convenient online submission Thorough peer review No space constraints or color figure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistribution Submit your manuscript at
World Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 3 Sigmoidorectal Intussusception Presenting as Prolapse Per Anus in an Adult Venugopal Hg Hasmukh B. Vora Mahendra S. Bhavsar SMT.NHL
More informationCase Report A Rare Case of Mucinous Adenocarcinoma of the Colon Presenting as Ileoileal Intussusception in an Adult
Case Reports in Medicine Volume 2012, Article ID 340947, 4 pages doi:10.1155/2012/340947 Case Report A Rare Case of Mucinous Adenocarcinoma of the Colon Presenting as Ileoileal Intussusception in an Adult
More informationUncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception
Case Report Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception Karl Mrak Department of Surgery, Brothers of Mercy Hospital, St. Veit, Glan, Austria Correspondence
More informationAdult Intussusception
Bahrain Medical Bulletin, Vol. 27, No. 3, September 2005 Adult Intussusception Suhair Alsaad, MBCHB, CABS, FRCSI* Mariam Al-Muftah, MBCHB** Objectives: Adult intussusception is a rare entity. We present
More informationSmall Bowel Intussusception in an Adult due to Lipoma: a Rare Cause of Obstruction. Case report and Literature Review
ISPUB.COM The Internet Journal of Surgery Volume 25 Number 1 Small Bowel Intussusception in an Adult due to Lipoma: a Rare Cause of Obstruction. Case report and Literature Review Yashpal, M Bansal, A Kudva
More informationJMSCR Vol 05 Issue 08 Page August 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i8.40 Original Article Adult Intussusception:
More informationIntussusception Secondary to a Meckel Diverticulum in an Adolescent
48) Intussusception Secondary to a Meckel Diverticulum in an Adolescent Yener O., Demir M., Yigitbaşı R. Department of Surgery, Göztepe Training and Research Hospital, Istanbul, Turkey Received March 28,
More informationCaeco-colic Intussusception Simulating an Appendicular Mass
Article ID: WMC003206 ISSN 2046-1690 Caeco-colic Intussusception Simulating an Appendicular Mass Corresponding Author: Dr. Matthew O Adelekan, Surgeon, North manchester General Hospital - United Kingdom
More informationSurgical Gastroenterology
Tropical Gastroenterology 2011;32(1):45 49 Surgical Gastroenterology Adult intussusception: Is associated bowel gangrene common? Dharmendra Prasad, Debajyoti Mohanty, Pankaj Kumar Garg, Vivek Agarwal,
More informationOutcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts Correspondence to
East and Central African Journal of Surgery http://www.bioline.org.br/js 9 Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts
More informationCase Report Ileocecal Intussusception due to a Lipoma in an Adult
Case Reports in Surgery Volume 2012, Article ID 684298, 4 pages doi:10.1155/2012/684298 Case Report Ileocecal Intussusception due to a Lipoma in an Adult Mehmet Bilgin, 1 Huseyin Toprak, 1 Issam Cheikh
More informationInternational Journal of Surgery
International Journal of Surgery 9 (2011) 91e95 Contents lists available at ScienceDirect International Journal of Surgery journal homepage: www.theijs.com Intussusception in adults: Institutional review
More informationA giant intraluminal lipoma presenting with intussusception in an adult: a case report
Ongom et al. Journal of Medical Case Reports 2012, 6:370 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access A giant intraluminal lipoma presenting with intussusception in an adult: a case report Peter
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 6 Case report: Intussusception of the colon through a colostomy: A rare presentation of colonic intussusception. Dr. Nora Trabulsi Dr.
More informationEast and Central African Journal of Surgery Volume 12 Number 1 - April 2007
Surgically Treated Acute Abdomen at Gondar University Hospital, Ethiopia. 53 S. Tsegaye 1, M. Osman 2, A. Bekele 3, 1 School of public Health, University of Gondar, 2 Associate Professor of Surgery, University
More informationRecurrent adult jejuno-jejunal intussusception due to inflammatory fibroid polyp Vanek s tumour: a case report
Joyce et al. Diagnostic Pathology 2014, 9:127 CASE REPORT Open Access Recurrent adult jejuno-jejunal intussusception due to inflammatory fibroid polyp Vanek s tumour: a case report Kenneth M Joyce 1*,
More informationIntussusceptions in Adults: A Retrospective Interventional Series of Cases
Original Article Intussusceptions in Adults: A Retrospective Interventional Series of Cases Rakesh Kr Gupta 1, Chandra Shekhar Agrawal 1, Rohit Yadav 1, Amir Bajracharya 1, Panna Lal Sah 2 1 Department
More informationAdult intussusception: a six-year experience at a single center
Original article Annals of Gastroenterology (2012) 25, 1-5 Adult intussusception: a six-year experience at a single center Digvijay Sarma, Raghunath Prabhu, Gabriel Rodrigues Kasturba Medical College,
More informationA rare cause of abdominal pain and gastrointestinal bleeding: Colonic lipoma causing intussusception
www.edoriumjournals.com CLINICAL IMAGES PEER REVIEWED OPEN ACCESS A rare cause of abdominal pain and gastrointestinal bleeding: Colonic lipoma causing intussusception Daniela Ferreira, Marta Salgado, Isabel
More informationFrequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema
Bahrain Medical Bulletin, Vol.24, No.3, September 2002 Frequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema Najeeb S Jamsheer, MD, FRCR* Neelam. Malik, MD, MNAMS** Objective: To
More informationPeutz Jegher's Syndrome (Gastro-intestinal Polyposis) and Its Complications
Peutz Jegher's Syndrome (Gastro-intestinal Polyposis) and Its Complications Pages with reference to book, From 154 To 155 Zakiuddin G. Oonwala, Sina Aziz ( Department of Surgery, Dow Medical College and
More informationIntussusception due to rectal adenocarcinoma in a young adult: A case report
Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.3748/wjg.v20.i35.12678 World J Gastroenterol 2014 September 21; 20(35): 12678-12681 ISSN 1007-9327
More informationCaeco-colic Intussusception Simulating an Appendicular Mass
Article ID: ISSN 2046-1690 Caeco-colic Intussusception Simulating an Appendicular Mass Corresponding Author: Dr. Matthew O Adelekan, Surgeon, North manchester General Hospital - United Kingdom Submitting
More informationPreoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma
377 Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma Hiroaki Shiba a Yoshinobu Mitsuyama a Ken Hanyu a Kenji Ikeuchi b Hirotaka Hayashi c Katsuhiko Yanaga a a Department of
More informationManagement of Perforated Colon Cancers
Management of Perforated Colon Cancers Introduction Colon and rectal cancers are the most common gastrointestinal cancers. They are 3 rd most common and 2 nd most common causes of cancer deaths among men
More informationColo-Colonic Intussusception Caused by a Submucosal Lipoma
168 Colo-Colonic Intussusception Caused by a Submucosal Lipoma Case Report and Review of the Literature B.A. Twigt S.K. Nagesser D.J.A. Sonneveld Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
More informationAdult Intussusception: A Complication of Metastatic Melanoma or Primary Malignancy?
January 2013 Adult Intussusception: A Complication of Metastatic Melanoma or Primary Malignancy? Johanna Sheu, Harvard Medical School Year III 1 Agenda Menu of tests Definition/anatomy/classification Pediatrics
More informationUniversity of Groningen. Colorectal Anastomoses Bakker, Ilsalien
University of Groningen Colorectal Anastomoses Bakker, Ilsalien IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationReferral Criteria for Direct Access Outpatient Colonoscopy or Computed Tomography Colonography
Referral Criteria for Direct Access Outpatient Colonoscopy or Computed Tomography Colonography 2019 Released 2019 health.govt.nz Citation: Ministry of Health. 2019. Referral Criteria for Direct Access
More informationADULT INTUSSUSCEPTION SECONDARY TO LYMPHANGIOMA OF THE CECUM: A CASE REPORT
ADULT INTUSSUSCEPTION SECONDARY TO LYMPHANGIOMA OF THE CECUM: A CASE REPORT Chin-Fan Chen, 1 Chieh-Han Chuang, 2 Chien-Yu Lu, 3 Ching Hu, 4 Ting-Lu Kuo, 5 and Jan-Sing Hsieh 2,6 Departments of 1 Surgery,
More informationDR JAIKISHOR JOTHIRAJ MD POST GRADUATE DEPT OF RADIODIAGNOSIS
DR JAIKISHOR JOTHIRAJ MD POST GRADUATE DEPT OF RADIODIAGNOSIS YASHODAMMAL 70 YRS OD LADY had C/o diffuse lower abdominal pain 20 days h/o blood in stools 4 days h/o vomiting 2 days h/o burning micturation
More informationCOLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE PROFESSOR OF SURGERY & DIRECTOR, PROFESSIONAL DEVELOPMENT CENTRE J I N N A H S I N D H M E D I C A L U N I V E R S I T Y faisal.siddiqui@jsmu.edu.pk
More informationIn children 3 months to 3 years of age intussusception is
Baird Mallory, MD, 1 and Yale Popowich, MD 2 In children 3 months to 3 years of age intussusception is one of the most common causes of a distal small bowel obstruction. It is often associated with intermittent
More informationRevista Colombiana de Gastroenterología ISSN: Asociación Colombiana de Gastroenterologia Colombia
Revista Colombiana de Gastroenterología ISSN: 0120-9957 revistagastro@cable.net.co Asociación Colombiana de Gastroenterologia Colombia Poveda P, Gustavo; Polanía L, Héctor Adolfo; Canal D., Fermín; Montoya
More informationClinical Study Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcomein33PatientsinaTertiaryCareCenter
Hindawi Publishing Corporation Journal of Oncology Volume 2008, Article ID 212067, 5 pages doi:10.1155/2008/212067 Clinical Study Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcomein33PatientsinaTertiaryCareCenter
More informationCASE REPORT LIPOMATOUS POLYP OF THE LARGE INTESTINE PRESENTING WITH INTUSSUSCEPTION
LIPOMATOUS POLYP OF THE LARGE INTESTINE PRESENTING WITH INTUSSUSCEPTION Sarvesh B.M 1, Gowri Sankar R 2, Lakshmana Rao 3, C.S. Subbramanian 4, P. Viswanathan 5 HOW TO CITE THIS ARTICLE: Sarvesh BM, Gowri
More informationTransient small bowel intussusception in an adult: case report with intraoperative video and literature review
Aref et al. BMC Surgery (2015) 15:36 DOI 10.1186/s12893-015-0020-6 CASE REPORT Open Access Transient small bowel intussusception in an adult: case report with intraoperative video and literature review
More informationCase Report Perforated Closed-Loop Obstruction Secondary to Gallstone Ileus of the Transverse Colon: A Rare Entity
Case Reports in Surgery Volume 2015, Article ID 691713, 4 pages http://dx.doi.org/10.1155/2015/691713 Case Report Perforated Closed-Loop Obstruction Secondary to Gallstone Ileus of the Transverse Colon:
More informationRetrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai
Original Research Article Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai S. Vijayalakshmi 1, Sriramchristopher M 2* 1 Associate
More informationGRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM
GASTROENTEROLOGY 64: 1071-1076, 1973 Copyright 1973 by The Williams & Wilkins Co. Vol. 64, No.6 Printed in U.S.A. GRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM JAMES A. NELSON,
More informationDepartment of Surgery, Aizu Central Hospital, Fukushima
Case Reports Resection of Asynchronous Quadruple Advanced Colonic Carcinomas Followed by Reconstruction with Ileal Interposition between the Transverse Colon and Rectum Sho Mineta 1, Kimiyoshi Shimanuki
More informationSmall Bowel and Colon Surgery
Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 3/ Issue 37/Aug 21, 2014 Page 9696
DISSEMINATED TUBERCULOSIS PRESENTING AS ILEO-COLIC INTUSSUSCEPTION: CASE REPORT AND REVIEW OF LITERATURE Jomine Jose 1, Vergis Paul 2, Anup Paul Varkey 3, Danny Joy 4 HOW TO CITE THIS ARTICLE: Jomine Jose,
More informationIleo-rectal anastomosis for Crohn's disease of
Ileo-rectal anastomosis for Crohn's disease of the colon W. N. W. BAKER From the Research Department, St Mark's Hospital, London Gut, 1971, 12, 427-431 SUMMARY Twenty-six cases of Crohn's disease of the
More informationListed below are some of the words that you might come across concerning diseases and conditions of the bowels.
Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Abscess A localised collection of pus in a cavity that is formed by the decay of diseased
More informationClinical presentations of small bowel tumor
Original Research Article Clinical presentations of small bowel tumor Arige Subodh Kumar 1*, N L Eshwar Prasad 2, Avula Krishnaveni 3, Anuradha 4 1 In-charge Professor, Department of Plastic Surgery, Gandhi
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
: Online published version of an accepted article before publication in the final form. Journal Name: Journal of Case Reports and Images in Surgery Type of Article: Case Report Title: Intussusception in
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 4, Issue 1 2014 Article 5 Giant Rectal Lipoma Treated By TEM: Report Of A Case Rutger Franken Daan Moes Sanne Veltkamp Eric Derksen Slotervaart hospital Amsterdam,
More informationISSN East Cent. Afr. J. surg. (Online)
143 Barium enema with reference to rectal biopsy for the diagnosis and exclusion of Hirschsprung disease W. Esayias 1, Y. Hawaz 1, B. Dejene 2, W. Ergete 3 Department of Radiology, School of Medicine,
More informationGallstone ileus:diagnostic and therapeutic dilemma
Saurabh et al. 1 CASE SERIES OPEN ACCESS Gallstone ileus:diagnostic and therapeutic dilemma Shireesh Saurabh, Andrew Camerota, Jeffrey Zavotsky ABSTRACT Introduction: Gallstone ileus is a rare complication
More informationNon-Neonatal Intestinal Obstruction in children: 3 Years Experience and review of literature.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 14, Issue 10 Ver.VII (Oct. 2015), PP 52-57 www.iosrjournals.org Non-Neonatal Intestinal Obstruction in
More informationPathology of Intestinal Obstruction. Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College
Pathology of Intestinal Obstruction Dr. M. Madhavan, MBBS., MD., MIAC, Professor of Pathology Saveetha Medical College Pathology of Intestinal Obstruction Objectives list the causes of intestinal obstruction
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 2 2013 Article 18 Revenge of the Christmas Turkey; Unusual Presentation of Colonic Perforation Secondary to Foreign Body. Mashuk Khan Sudeep Thomas Warwick
More informationEndoscopic Detection and Removal of Recto-sigmoid Myomatous (Leiomyoma) Tumour
Article ID: ISSN 2046-1690 Endoscopic Detection and Removal of Recto-sigmoid Myomatous (Leiomyoma) Tumour Author(s):Mr. Sridhar Dharamavaram, Dr. Ritu Kamra, Dr. Anu Priya, Mr. Rajiva Ranjan Das Corresponding
More informationCompound and Multiple intussusceptions caused by inverted Meckel s diverticulum: A rare case report
Case Report: Compound and Multiple intussusceptions caused by inverted Meckel s diverticulum: A rare case report Jaykar R D 1, Jadhav S C 2, Bhushan C 3, *Kamble P H 4 1 Associate professor, General Surgery,,
More informationDefining incidence of intussusception (IS) in Bangladesh in preparation for a phase III trial of a new Rotavirus vaccine
Defining incidence of intussusception (IS) in Bangladesh in preparation for a phase III trial of a new Rotavirus vaccine Principal Investigator: Dr. K. Zaman Final Report June 1, 2007 1 This study was
More informationUNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN
UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a
More informationIntestinal Obstruction Clinical Presentation & Causes
Intestinal Obstruction Clinical Presentation & Causes V Chidambaram-Nathan Consultant Transplant and General Surgeon Sheffield Kidney Institute Northern General Hospital Intestinal Obstruction One of the
More informationAdult intussusception: Case series
Case Report Adult intussusception: Case series Garg P, Garg G, Verma S, Mittal S, Rathee VS, Narang A, Aggarwal S ABSTRACT Adult intussusception occurs infrequently and differs from childhood intussusception
More informationJMSCR Vol 05 Issue 06 Page June 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-45 DOI: https://dx.doi.org/1.18535/jmscr/v5i6.1 Clinical-Epidemiological Study of Abdominal
More informationI. Intussusception in Children: Diagnostic Imaging and Treatment
1 I. Intussusception in Children: Diagnostic Imaging and Treatment II. Author Kimberly E. Applegate, MD, MS Indiana University Department of Radiology Riley Hospital for Children 702 Barnhill Rd., Rm 1053b
More informationThe Value of Urgent Barium Enema and Computed Tomography in Acute Malignant Colonic Obstruction: Is Urgent Barium Enema Still Necessary?
J Radiol Sci 2012; 37: 105-110 The Value of Urgent Barium Enema and Computed Tomography in Acute Malignant Colonic Obstruction: Is Urgent Barium Enema Still Necessary? Chun-Chao Huang 1,2 Fei-Shih Yang
More informationstudy was undertaken to assess the epidemiology, course and outcome of UC patients attending a hospital in Jordan.
Ulcerative colitis (UC) is a relatively uncommon, chronic, recurrent inflammatory disease of the colon or rectal mucosa [1]. Often a lifelong illness, the condition can have a profound emotional and social
More informationSurgical Apgar Score Predicts Post- Laparatomy Complications
ORIGINAL ARTICLE Surgical Apgar Score Predicts Post- Laparatomy Complications Dullo M 1, Ogendo SWO 2, Nyaim EO 2 1 Kitui District Hospital 2 School of Medicine, University of Nairobi Correspondence to:
More informationGuidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer
SAGES Society of American Gastrointestinal and Endoscopic Surgeons http://www.sages.org Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer Author : SAGES Webmaster PREAMBLE The following
More informationJMSCR Vol 05 Issue 04 Page April 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i4.206 Acute Presentations of Abdominal Tuberculosis
More informationADULT RETROGRADE INTUSSUSCEPTION Brian Tiu Richmond University Medical Center September 3, 2015
ADULT RETROGRADE INTUSSUSCEPTION Brian Tiu Richmond University Medical Center September 3, 2015 CASE PRESENTATION 41 yo woman presented one day hx abdominal pain, worsening nausea/vomiting denied flatus/bm
More informationThis is the portion of the intestine which lies between the small intestine and the outlet (Anus).
THE COLON This is the portion of the intestine which lies between the small intestine and the outlet (Anus). 3 4 5 This part is responsible for formation of stool. The large intestine (colon- coloured
More informationTariq O Abbas *, Ahmed Hayati and Mansour Ali
Abbas et al. BMC Research Notes 2012, 5:550 SHORT REPORT Open Access Role of laparoscopy in non-trauma emergency pediatric surgery: a 5-year, single center experience a retrospective descriptive study
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 09/17/2011 Radiology Quiz of the Week # 38 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationCASE REPORT GASTRODUODENAL INTUSSUSCEPTION SECONDARY TO GASTROINTESTINAL STROMAL TUMOR AS LEAD POINT A CASE REPORT
GASTRODUODENAL INTUSSUSCEPTION SECONDARY TO GASTROINTESTINAL STROMAL TUMOR AS LEAD POINT A Muraliswar Rao J 1, Narvekar V.N 2, Priyanka Rao S 3, Rakesh Kumar Nanna 4, Vinay Varma P 5 HOW TO CITE THIS ARTICLE:
More informationPedunculated lipoma causing colo-colonic intussusception: a rare case report
Mouaqit et al. BMC Surgery 2013, 13:51 CASE REPORT Pedunculated lipoma causing colo-colonic intussusception: a rare case report Ouadii Mouaqit 1,3*, Hafid Hasnai 1, Leila Chbani 2, Abdelmalek Oussaden
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 14 ISSUE 1 Diffuse Intestinal Lipomatosis Presenting as Adult Intussusception Christopher W. Snyder Jamie A. Cannon University of Alabama
More informationPatologia sistematica V Gastroenterologia Prof. Stefano Fiorucci. Colon polyps. Colorectal cancer
Patologia sistematica V Gastroenterologia Prof. Stefano Fiorucci Colon polyps Colorectal cancer Harrison s Principles of Internal Medicine 18 Ed. 2012 Colorectal cancer 70% Colorectal cancer CRC and colon
More informationTwice recurrent gallstone ileus: a case report
Jones et al. Journal of Medical Case Reports 2012, 6:362 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Twice recurrent gallstone ileus: a case report Rhys Jones 1*, Daniel Broman 1, Richard Hawkins
More informationONE of the most severe complications of diverticulitis of the sigmoid
CLEVELAND CLINIC QUARTERLY Copyright 1970 by The Cleveland Clinic Foundation Volume 37, July 1970 Printed in U.S.A. Colonic diverticulitis with perforation to region of left hip: a rare complication Report
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
Early View Article: Online published version of an accepted article before publication in the final form. Journal Name: Journal of Case Reports and Images in Surgery Type of Article: Case Report Title:
More informationLarge polyps: EMR, ESD, TEM and segmental resection. Terry Phang 2017 SON fall update
Large polyps: EMR, ESD, TEM and segmental resection Terry Phang 2017 SON fall update Key Points: Large polyps No RCT re: Recurrence, complications Piecemeal vs en bloc: EMR vs ESD Partial vs full-thickness:
More informationSMALL BOWEL ADENOCARCINOMA. Dr. C. Jeske
SMALL BOWEL ADENOCARCINOMA Dr. C. Jeske Case presentation 54 year old female. Presents with OJ and weight loss. Abdominal examination only reveals a palpable gallbladder. ERCP reveals a circumferential
More informationIntestinal Obstruction
By the Name of ALLAH the Most Gracious the Most Merciful Intestinal Obstruction د. أحمد اسامة حسن Specialist in General Surgery and Laparoscopic Surgery To be read in Bailey & Love s Short Practice of
More informationIntussusception; A to Z
Intussusception; A to Z Poster No.: C-0104 Congress: ECR 2014 Type: Educational Exhibit Authors: S. W. Shin, Y. Kim, E. T. Kim, M. Y. Kim ; Kuri city/kr, 1 1 2 1 1 2 Cheonan/KR Keywords: Gastrointestinal
More informationRe-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy: a case report
Bisicchia and Tudisco BMC Musculoskeletal Disorders 2013, 14:285 CASE REPORT Open Access Re-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy:
More informationFig. 1. Ileal and jejunal metastases from adenocarcinoma of the lung in 62-year-old male with a clinical history of bloody stool. A.
507 A B Fig. 1. Ileal and jejunal metastases from adenocarcinoma of the lung in 62-year-old male with a clinical history of bloody stool. A. An intraluminal polypoid mass (arrow) is seen in the dilated
More informationIleocolic Intussusception Due to Endometriosis
CASE REPORT Ileocolic Intussusception Due to Endometriosis Ioannis Koutsourelakis, MD, Haris Markakis, MD, Spiros Koulas, MD, Nikolaos Mparmpantonakis, MD, Eleni Perraki, MD, Kallinikos Christodoulou,
More informationSurgical Management of IBD. Val Jefford Grand Rounds October 14, 2003
Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two
More informationACUTE ABDOMEN IN ADULTS: A TWO YEAR EXPERIENCE IN MEKELLE, ETHIOPIA. ABSTRACT
19 Mekonnen Hagos. Ethiop Med J,2015, Vol. 53, No. 1 ORIGINAL ARTICLE ACUTE ABDOMEN IN ADULTS: A TWO YEAR EXPERIENCE IN MEKELLE, ETHIOPIA. Mekonnen Hagos, MD 1 ABSTRACT Background: The term acute abdomen
More informationMohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University.
Mohamed EL-hemaly Gastro- intestinal surgical center, Mansoura University. Chronic transmural inflammatory process of the bowel & affects any part of the gastro -intestinal tract from the mouth to the
More informationד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה Presentaion: S.A is 38 years old. Referred for rectal bleeding investigation. Describes several occasions of bleeding and abdominal pain.
More informationThe Pattern of intestinal Obstruction at Kibogola Hospital, a Rural Hospital in Rwanda
The Pattern of intestinal Obstruction at Kibogola Hospital, a Rural Hospital in Rwanda G. Ntakiyiruta 1, B. Mukarugwiro 2 1 Department of Surgery, Faculty of Medicine, Kigali University Teaching hospital,
More informationCase Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder in an Elderly Patient
Case Reports in Surgery Volume 2015, Article ID 767196, 4 pages http://dx.doi.org/10.1155/2015/767196 Case Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder
More informationFiliform polyposis of ulcerative colitis
Filiform polyposis of ulcerative colitis Authors: Keisuke Yamada, Hironori Samura, Tatsuya Kinjo, Tetsu Kinjo, Akira Hokama, Jiro Fujita Article type: Clinical image Received: December 7, 2018. Accepted:
More informationBurkitt s Lymphoma of the Abdomen: The Northern California Kaiser Permanente Experience
ISPUB.COM The Internet Journal of Surgery Volume 18 Number 2 Burkitt s Lymphoma of the Abdomen: The Northern California Kaiser Permanente Experience J McClenathan Citation J McClenathan. Burkitt s Lymphoma
More informationCase Report A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient
Case Reports in Surgery Volume 2016, Article ID 2893925, 4 pages http://dx.doi.org/10.1155/2016/2893925 Case Report A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent
More informationTRANSOMENTAL HERNIATION CAUSING ACUTE INTESTINAL OBSTRUCTION N. Suresh Kumar 1, Rahul Rai 2, P. Kulandai Velu 3
TRANSOMENTAL HERNIATION CAUSING ACUTE INTESTINAL OBSTRUCTION N. Suresh Kumar 1, Rahul Rai 2, P. Kulandai Velu 3 HOW TO CITE THIS ARTICLE: N. Suresh Kumar, Rahul Rai, P. Kulandai Velu. Transomental Herniation
More informationColon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition
Colon and Rectum Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix are excluded. Protocol revision date: January
More informationISPUB.COM. P Johnson, S Shah, D Soares INTRODUCTION
ISPUB.COM The Internet Journal of Radiology Volume 9 Number 2 Air insufflation for the treatment of intussusception in the Radiology Department at the University Hospital of the West Indies (UHWI) between
More informationNordic Forum - Trauma & Emergency Radiology. Bowel Obstruction: Imaging Update
Nordic Forum - Trauma & Emergency Radiology Bowel Obstruction: Imaging Update Borut Marincek Institute of Diagnostic Radiology University Hospital Zurich, Switzerland Acute Abdomen Bowel Obstruction Bowel
More information